Abstract 16021: A Changing and Complex Phenotype of Heart Failure in the Community Setting: Trends in Comorbidity, Disability, and Polypharmacy
Background: There is growing concern that clinical practice guidelines fail to adequately address the complexity of patients with heart failure. Patients with heart failure are generally older, and their care is commonly complicated by comorbidity, disability, and polypharmacy. These factors can change biological response to therapy, reduce patient ability to adhere to recommendations, and alter patient preference for treatment and outcome. Yet, a comprehensive understanding of the complexity of patients with heart failure is lacking. Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally-representative, community-based heart failure population. We hypothesize that patients with heart failure have become substantially more complex - patients are older and have greater comorbidity, disability, and medication burden.
Methods: Using data from the National Health and Nutrition Examination Survey, we analyzed trends in demographics, comorbidity, physical function, and medication use in participants with heart failure across three survey periods (n=581 in 1988-1994, n=280 in 1999-2002, n=534 in 2003–2008).
Results: The proportion of persons with heart failure that was >= 80 years old increased from 13.3% in 1988–1994 to 22.4% in 2003–2008. The proportion of persons with heart failure that had five or more comorbid chronic conditions increased from 40.3% to 57.5%. The mean number of prescription medications increased from 4.1 prescriptions to 6.4 prescriptions. All trends were significant at the P<.01 level. The prevalence of disability did not increase but was substantial across all years. In 2003–2008, 56.9% of participants were mobility disabled and 11.1% were activities-of-daily-living disabled.
Conclusion: The phenotype of patients with heart failure changed dramatically over the last two decades. Most notably, more recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed. These changes suggest a need for new educational, research, and practice strategies that accommodate the changing characteristics of this population.
- © 2010 by American Heart Association, Inc.